Is It Safe to Train When the Air Is Full of Wildfire Smoke?

0:00 This podcast is brought to you by 10,000. I was super excited to learn that 10,000 wanted to sponsor our podcast. Mostly because I've been buying their stuff for a long time now. Specifically, I started with their interval short and I've worn them for everything. While I lift, while I run, cuz I'm trying to be a hybrid athlete, when I'm practicing golf in the backyard or when I'm running errands. These things go everywhere. The fit is what I noticed first. These things are awesome.

0:25 And then it was the pockets. I can fit everything in there. my phone, my keys, my wallet, and they don't bounce around. There's also a zip pocket on the side, so when I go running, I can put my keys in there. And there's a liner for where the phone goes so that I don't sweat through the shorts and onto my phone. They're also four-way stretch. There's no pinch in the waistband, and they're gusseted so they don't ride up. I've got a pair I've been wearing for over 3 years now, and they show no signs of slowing down. Now, the price is real, but you can see where it goes. If you want to check them out, head over to 10,000.cc.

0:55 That's 10,000.cc CC and use code podcast15 for 15% off your first order. That's 10,000.cc code podcast 15. 10,000 built for however you train. Welcome back to the barbell medicine podcast. I'm Dr. Jordan Fagenbomb and what you're about to hear is a free preview of the direct line, our monthly ask us anything for our barbell medicine plus subscribers. We had about a dozen questions this month and we're going to talk about two here. The first one is on training in wildfire smoke. And depending on where you live, that could be a few weeks out of the year where you're exposed to wildfire smoke. And the question is whether the air quality gets bad enough that the workout causes more harm than good.

1:37 There's some new data on that, so we're going to talk about it. And the second question is about the effective reps model and the idea that only hard sets count towards your gains. But that doesn't really square with the fractional sets idea. So it goes something like this. If a set only counts when you're within five repetitions of failure, then the triceps contribution in a heavy bench press shouldn't count. But if you're going to count that as a fractional set for the triceps, then a warm-up set should count for the chest. Both of those things can't be true. So, we're going to argue about it. And with me as always is the second most handsome doctor in North America, Dr. Austin Barack. What's going on, man?

2:13 >> Again, you're really setting out some ambitious goals for the collective us today to tackle all of these things. Well, you know, I think when I was writing, I try to write a little something funny, you know, to introduce you because it brings me great pleasure and I only have so many creative outlets. In my in my in my head, the way that you answer all of this, you know, how should I rely on the air quality app?

2:36 What do I think about a steroid taper? What do I think about the effective reps? I don't care. >> I'm kidding. You probably care about the steroid taper more than any of that, but >> yeah, fair enough. >> All right. Well, let's get into it. Okay, the question is, we are entering into the part of the year where some parts of the country are impacted by wildfire smoke and sometimes for weeks at a time. I understand that exercise reduces health risks and PM2.5, that's particulate matter, 2.5, we'll talk about that, raise health risks. Is there some crossover point above which a workout does net harm from a performance and health point of view? Am I right in saying that the crossover point for lifting and aerobic exercise are different since I usually lift indoors and don't breathe as heavily? I'm aware of the Teneo paper, but I'm not used to interpreting that sort of literature. I think that makes three of us on this.

3:27 Now, all we do have some expertise in interpreting research and applying it clinically. So, you know, we have a a good I call it a pinball machine of sort of like orientation. and you try to find different those little I don't know what they're called in the pinball machine on the way down where the ball hits and you're like oop that trips me up. I need to figure out if that's legit or not, but we'll see if we can get you an answer here. So, we're starting with the PM 2.5. This is any partic particle in the air smaller than 2 and a half microns across. That's small enough to slip past your nose and your throat.

3:58 So, it goes deep into the small airways u and into your blood. That's that's what we think. it's measured by weight, micrograms per cubic meter of air. So on a clean day, that number is usually in the single digits around five, but wildfire smoke can push it up to 100, sometimes past 150. Now that is different from what's on like the weather app, the AQI or air quality index. it takes in the concentration and puts it into a 0 to 500 scale. So every different pollutant reads out on one kind of scale. Less than 50 is green, good air. 50 to 100 is yellow, moderate, and above that it gets gets worse. Now, these are all 24-hour averages, the green, yellow, orange.

4:40 so now cast is usually what's used on on the phone. that's weighted towards the last few hours. So, if like smoke is rolling in, for example, the app can read meaningfully lower than what you're seeing. basically, because again, it's a it's an average. The Teneo paper he talks about, this is from 2016. This has been out obviously for for 10 years now. Now, this is a modeling paper. So, it's a simulation of years of city commuting, not like a heavy smoke day from wildfire. Again, it's mostly city city pollutants. his own authors say that short spikes weren't even modeled here, but so this is more like a framework type paper. They took a curve for how much exercise helps you and a curve for how much particulate matter hurts you. They plugged in some assumed breathing rates for each sort of situation and calculated exposure. They predicted that 90 minutes a day of cycling at 100 micrograms per cubic meter is the tipping point. Now, it's worth noting that the paper states the number three different ways. The abstract says an hour and a half. The discussion says an hour and 15, and the author's own follow-up review paper says just more than an hour. So, 90 minutes is the highest one that they list, but it's hard to feel confident whether it's an hour and a half or it's an hour 15 or just above an hour. So effectively, it had to be really like a a wildfire kind of exposure for 90 minutes. This is a modeling paper, but again, it's from city particulate matter, which is maybe different. we'll get to that.

6:02 Austin, before we get to those numbers, what sort of health concerns do you have generally speaking when somebody's breathing in air like this? yeah, so some of the specifics are definitely outside of my realm of expertise, but breathing in particulate matter in general starts to raise concerns in a few different realms. There is some variation depending on the type of particulate matter that is being inhaled. So you know in wildfires I suspect that it is going to be a bit more of this kind of fine particulate matter that is from like we'll call it organic materials like trees and forests and things like that. that is to be contrasted with inhalation of nonorganic types of like compounds from mineral dusts and things like that. So like you might remember from you know going through med school you get test questions about like sand blasters and like the types of lung issues that they get those are called pneumoconeiosis these kind of fib fibrosing sort of lung diseases that come from inhaling different types of particles those sorts of inorganic kind of mineral dusts and things like that. So here it's a little bit more what I suspect is like organic material, things like that. And and so the health concerns that I'm concerned with can be broken down into those affecting people with pre-existing lung disease and or cardiovascular disease.

7:21 So people who already have baseline COPD or emphyma, chronic bronchitis, asthma, other sorts of lung diseases, cuz those are the types of people that I see much more frequently when these types of things happen because I end up admitting them to the hospital more often for exacerbations of their COPD and asthma and things like that. Separate from that is what is the impact on them? That's like a short-term impact on a vulnerable population. The others would be what would be long-term impacts on people who have like healthy lungs at baseline. That is not probably as well characterized. I suspect that there is an increased risk of developing some of these chronic lung diseases.

7:58 There is certainly we know from inhaling things like even from cigarette smoke an increased risk of you know carcinogenesis and things like that. I suspect that it would take quite a lot of chronic exposure to wildfires to you know deliver a similar kind of dose cumulative dose exposure to to increase that risk to a substantial degree. And then there's almost certainly going to be some some cardiovascular risks as well. So those are kind of like the big picture breakdowns that I have is like what is the nature of the material that is being inhaled? How vulnerable is the person from a pulmonary and a cardiac standpoint? And then what's the cumulative exposure that we're talking about here? Would it be fair to say that most of these like particulate matter inhalation type issues you're worried about are due to some sort of reactivity at the level of the lungs whether it's like very acute causing like bronco spasm or like just general injury and then in inflammation and subsequent decreased function. Is that really the nature of this at its core? Yeah, I mean the the lungs are essentially exposed to the environment. You know, in the same way that our skin and our GI tract are organs that are essentially wide open to the external environment, our lungs are as well. So, it's no coincidence that they are a frequent site of pathology, of infection, of inflammation. There's tons of immune activity happening in the lungs. So you're right that something can very abruptly cause like a reactive you know bronospastic sort of process but you can also have things like hyper sensitivity pneumminitis basically a massive allergic reaction in the lungs.

9:25 We saw this type of thing happen for example when like vaping started to get really popular. There was that like you know ecigarette associated you know or vaping induced lung injury and things like that. So inhaling you know what we'll call foreign substances into the lungs can trigger a variety of responses and the nature of that response will again depend on the the host the person and their kind of genetic predisposition their allergic or attopic predisposition as well as what is the nature of the material that's being inhaled and what is the dose that they're being exposed to. I think that those are all of the different things that might influence what sort of reactive kind of process happens, how abrupt it is versus how chronic it is, the likelihood of developing cancer over very long periods of time and things like that with persistent exposure.

10:08 >> Yeah. Yeah. Well said. Okay. Well, the best evidence we have here is that this we'll call it dirty air blunts the benefits of exercise, but we can't really see a point where or tipping point where it erases it. And the AQI air quality index of 80 is where the benefit roughly halves. We just don't have any evidence that exercise ever becomes harmful in a particular environment. so this is a study in BMC medicine from last year. They took seven separate groups of people already followed for years and and then combined them. About a million and a half adults with a median 12 years of follow-up below 25 micrograms a year, which is an AQI of about 80. So basically Los Angeles hitting the exercise guidelines cut all cause mortality by about 30%.

10:51 Above that in a city worse than LA on average meeting the same guidelines still helped but the benefit was roughly cut in half down to around 12 to 15% in reduction of all cause mortality. Now the data we have here runs up to a dose of 50 micrograms which be which would be an AQI of 137 and it's still protective there. wildfires are kind of around 100 but obviously depends on the nature and size and you know your proximity to the to the fire all these things can change. Still in all seven groups that were followed, exercise still tracked with living longer, so some benefit.

11:23 a few caveats. This data set relies heavily on this sort of Taiwanese cohort. There are two two big studies there. The other studies didn't really show a separation here, including Hong Kong, which has like worse air quality, but still there's no real drop off there either. Just really couldn't parse what was going on here. There's another study that modeled six cities, Helsinki, London, Sa Paulo, Warsaw, Beijing, and New Delhi, and asked what happens if active commuters switch to transit or work from home on high pollution days.

11:52 The idea is, oh, reduced exposure. This should probably show a benefit. So, they tested it. Restricting these folks didn't lower mortality in a single one of those groups. In Beijing and Delhi, mortality actually went up from the reduced activity. At least that's what the model was tending to show. And again, this is a model. It's mostly about commuting, not not training or doing like intervals or anything like that. but it is, you know, one of the only studies here that actually asks whether hey, is it a higher risk to do the exercise versus not. Now, he's also right on the lifting here. The breathing rate which we sometimes call minute ventilation, the total volume of air that you move in and out in a minute generally is lower with lifting. So, at rest, you exchange about 10 L per minute, walking's 23, cycling's 43.

12:35 researchers when they have people do lifting, it's closer to walking than than cycling. It was pretty interesting study. What what they did is they had people both healthy individuals and folks with COPD. They had them do sets of 10 with 40% of their max leg extension as I recall and then again at 80% of their max and the breathing like did not increase. The effort increased, right? But their breathing rate and everything else did didn't. So, and I thought it was interesting that they also included COPD. Pretty elegant study there cuz you're like, well, look, if there's a vulnerable population, it's going to be somebody with a a lung disease. I think again a caveat here is that well, they didn't look at circuit training and they didn't look at high rep sets and when you do look at that, that does start to look more like conditioning, higher higher their sort of minute ventilation, which is what you would expect. and again, this is like a a single snapshot in time.

13:27 Nobody's like, "Okay, well, look, they did this during wildfires and like what happened?" And so we don't really have clinical outcomes there. I suspect that you know most people would in it that indoors is better and we would agree with that you have some barriers in place but during the cal some California wildfire fires researchers looked at over a thousand buildings during this time and even with people you know being indoors and there's filtering indoor particulate matter still nearly tripled basically because the outdoor air got so much worse that it still still came in. So, where I kind of end up here is that I would favor exercise like the majority of the time.

14:03 It'd have to be pretty bad outside such that you may be considering like, should we get out of here because like things are really bad. >> Yeah. >> Yeah. I I suspect the benefit to health would shrink, right? ma mainly because you're going to get some exposure, but man, that tipping point is still pretty high. For performance, it's actually much easier. I don't think that there's like not doing it is ever going to really help performance unless you were doing too much before. that said, you could also delay it and still be fine and it's not a huge deal.

14:32 would also favor indoor conditioning whenever possible. and again, most of this stuff is from city related stuff. pollution and wildfire may be may be different. and there's some evidence there. There was a scripts study where they looked atund sorry 1.6 6 million respiratory based admissions to the hospital and effectively in the city that particulate raised admissions by under one and a half% per 10 microgram exposure but wildfire was much more than that potentially anywhere from 1.3% up to 10%. So a pretty big range there and you know depending on how you interpret that you could say oh wildfire is much worse but again I think it depends on what the size of the fire is how close you are to it what's the nature of the burn I mean there's other stuff >> countless variables that we can't even comprehend or think about you know what direction is the wind blowing and how much of it and >> all all sorts of things. Yeah.

15:24 >> Yeah. So, and unfortunately no real updates on the masks here with respect to wildfire smoke. because somebody asked that in that forum reply about six years ago. So Austin, let's say you got a healthy patient in this situation. How are you approaching that that conversation if they're just asking you? and does that change if they have something like asthma and the sky is orange? Yeah, the well the color of the sky I wouldn't say is the predominant feature that would you know drive my my decision-m here but but rather the person's underlying vulnerability and what they're proposing to do. I think that if you know you're in a situation where there is a significant increase in airborne particulate matter to which you are very vulnerable susceptible maybe you are somebody who has a history of you know when this has happened in prior years I have ended up in the hospital with an exacerbation or I have needed to go on prennazone or use my inhaler way more than I typically do just to maintain control or to be able to breathe. It's like yeah those are all things that obviously should modify what you're doing now. And to your point, I would not avoid exercise, but I would strongly favor indoor exercise. And as you mentioned, you know, even being indoors is not foolproof. But that also means that there's like literally no escape in that situation unless you actually escape the area. So your options are like be inside and don't exercise or be inside and exercise in which case the being inside and exercise is in my mind more likely to benefit you than staying inside to avoid the m the particular matter and then not exercising out of fear of some detrimental effect which is again most likely outweighed by the the benefits in that in that situation. So that would be where I would lean for a vulnerable person. Did you have a did you have a take there?

16:58 >> yeah. So my take is this like if this is going to be temporary I think my concern over this almost drops to zero both in both ways. So like one if it's just a week for example and you're talking about you know three outdoor sessions that are again you're not doing three or four hours at a time like I'm I'm pretty unconcerned right but also if it's a week I'm also unconcerned if you take the week off right cuz it's like your training load and where the accounting for that sort of kicks in like oh we have fully realized all of the potential adaptations from the amount of training that you've done is not over a day it's not over a week it's not over two weeks it's many many months stacked on top of each other, right? And so I'm like, look, if you take the week off because there's some concern here. I have minimal concerns about this sort of acute decline in health as in in response to that or acute decline in performance in response to that. I think what the studies that we've been able to find here are more like yeah chronically though if people stopped exercising because it's so frequent or so pervasive in that environment that's where you would see a real sort of decline in sort of health and and and you know we would in it probably performance from there.

18:07 >> Well given that we like to try to turn things into contrived disagreement I'll push back on your push back here and I think it's more so an artifact of the types of folks that we work with the most often. So, you know, on your side, doing more in the in the coaching space with athletes who are more likely to be, you know, motivated and engaged in the process such that if they did happen to take a few days or to take a week off, it is almost a bakedin assumption because they have the same, you know, neurological affliction that affects you and I where we like can't stop training that we are guaranteed to come back the following week and get back on the horse. Whereas my experience much more than coaching these days working with patients and many patients who have for example struggled with various aspects of their health or their weight for long periods of time for whom you know taking a week off of exercise for this reason whether for the wildfire reason or for some other reason could evolve into 2 weeks off four weeks off 6 months later they're like well I took this one week off because of the wildfire and then I kind of lost momentum and I you know here we are 6 months or a year later and I haven't been able to get back to it. And so that's kind of my would be more my my concern. And of course this just means like yeah this stuff should be individualized to the person's situation. And but but that's kind of the perspective that I take and why my initial response was not a just you know take the week off. It's instead let's try to find a way to keep you active during the time in a way that's tolerable and doesn't flare up your you know if you have any breathing symptoms or intolerance or sensitivity or something like that.

19:32 >> Yeah. Yeah. If it affects adherence I'm I'm definitely with you for sure. >> Yeah. >> This podcast is brought to you by ButcherBox. I order groceries online constantly, which means I've made peace with a certain amount of disappointment. The produce always tests you, and the meat is a gamble. Half the time, I open it and think, "Well, I guess this is dinner now." Butcher Box is the opposite of that. They deliver grass-fed beef, organic chicken, wild caught seafood, and more, all sourced to standards that they're transparent about. Every box is customizable, so you pick the cuts and proteins that fit how you actually cook and what you like to eat. And you can change it up whenever you want. They've already done the sourcing homework, so the only thing left is deciding what you're making that night. and it tastes awesome. I've been grilling a lot and the quality is legit every time. It shows up at my door. It's ready when I want it and I know it's good. Whether you're grilling out on the weekend, you're feeding the family on a Tuesday, or just skipping another takeout order, you've already got something great ready to go. Go over to butcherbox.com/barbell to get $20 off your first box, plus your choice of a free ribeye, New York strip, or filt minion in every box for a year with free shipping always. That's butcherbox.com/barbell.

20:34 Be sure to use our link so they know we sent you. This podcast is brought to you by Factor. We just launched Signal and the weeks leading up to a book launch are not exactly relaxed. Late nights, deadlines, the kind of schedule where you look up and it's 9:00 p.m. and you haven't eaten anything since lunch. That's when food quality goes sideways. It's also when you have the least bandwidth to do anything about it. Or at least that's the case for me. And factor is how I've been keeping that from happening. These are chef crafted dietitian designed meals that are ready in 2 minutes. no prep, no cleanup, and over a hundred menu items that rotate every week, including new options like salmon burgers, shredded pork, and collard greens. They also have add-ons like protein shakes and pumpkin cheesecakes if you want them. And there are over 100 different banned ingredients so that the stuff you don't want isn't in there. When time gets crunched, I use Factor, and you should, too. Head over to factormeals.com/bm50 off and use code BBM50 off to get 50% off and one free breakfast item per box for one year while supplies last until October 31st, 2026. That's code BBM50 off at factormeals.com. See the website for more details.

21:41 Have you ever noticed that you end up wearing the same few items on repeat? Or is it just me? Now, I work from home most days, but I still get ready to head to the office every day, which fortunately is just down the hall. Anyway, last month, I finally noticed I was wearing the same items over and over again because, well, they just work well. They make getting dressed easy. That's what Quint does best. Their organic cotton mesh stitch sweater polo is one. I have it in almost every color.

22:06 And the vintage wash camp shirts are another that's been in heavy rotation all summer because I think it looks better than t-shirt and it's just as comfortable. They also do premium pants, fitted TE's, and polos, plus breathable activew wear. Everything is priced 50 to 80% less than comparable brands because they work directly with Ethical Factories, and they skip the middlemen. And it goes past clothing. They do bath and kitchen essentials and even hotel quality bedding, which I also bought before they even sponsored this podcast.

22:32 So find your next fall favorites at Quint. Download the Quint app for app exclusive offers or go to quint.com/bm. You can get free shipping on your order and 365day returns. now available in Canada and in the UK, too. That's qi nce.com/bbm. This podcast is brought to you by FIGS. Here's a piece of medical history that we didn't learn in school. Before the 1920s, pretty much everything in the operating room was white. The attire, the walls, everything. And the logic was cleanliness. The problem is that surgeons spent hours focusing on red tissue under the bright O lights. and then their red photo receptors fatigued and every time they would glance away from the white fabric, they would see a blue green ghost of whatever they were just looking at. So surgeons were getting headaches and seeing phantom anatomy mid-operation. But the fix turned out to be pretty simple. Surround the surgical field with the color that sits directly opposite red and it cancels out, which is why scrubs are green and blue today. Figs took the same approach with scrub design. They are innovative. They're lightweight. They're actually tailored and they're antimicrobial. Plus, they're also built to survive the laundry. So, no more boxy, big, scratchy scrubs. Figs rethought them completely with better tailoring and tons of styles and colors to choose from. And it's not just scrubs. They've teamed up with New Balance for supportive sneakers. They make compression socks for long days on your feet. And they have outerwear for when the hospital AC is on full blast.

23:56 If you want to check them out, Figs is offering 15% off your first purchase. Just go to wearfigs.com and use the code figs rx at checkout. That's wearfigs.com. code figs RX for 15% off. This podcast is brought to you by FIGS. Here's a piece of O history. Before the 1920s, pretty much everything in the operating room was white. The logic was cleanliness. The problem is that surgeons spend hours staring at red tissue under bright lights and then their red photo receptors would fatigue and so every time they would glance away at the white fabric, they would see a blue green ghost of whatever they were just looking at. An anesthesiologist in New York figured out that if you surround the field with green, the color directly opposite of red, it would cancel out, so he built a fabric for it, and scrubs never went back to white after that. Figs took the same approach with scrub design. They're lightweight, they're actually tailored, they're antimicrobial, and they're built to survive the laundry. They have way more styles and colors than the standard issue approach ever offered. and they collaborate with brands like New Balance for footwear, compression socks for long shifts, and outerwear for when the hospital AC is on full blast. Get 15% off your first purchase at wearfigs.com using codef figs rx. That's wearfigs.com. Codef figs rx. All right, your favorite question I think of this whole this whole podcast. We're talking about hard sets again. So, how do you understand the relationship between reps and reserve ri hard sets and fractional sets? This is the straw man of the statement. The person writes, "The general rhetoric is that if you aren't lifting to five repetitions in reserve or less, you aren't building much muscle. That seems fair, but if that is the case, how does that reconcile with fractional sets from compound exercises? For example, a set of heavy bench. Are the triceps really hitting that under five reps and reserve point? If not, why count the set at all for the triceps? And if it is counted as fractional for the triceps, shouldn't warm-up sets that are over five repetitions in reserve counts as fractional sets for the chest. so yeah, just some definitions here. Reps and res is reps in reserve. How many more you could have done, right? Where an RI of zero is a maximal set all the way to failure and an R of five means you have five reps left in the tank. A hard set is one taken close enough to failure that people are willing to count with this sort of arbitrary line in the sand drawn at five. and a fractional set is when a muscle works as sort of a secondary mover or a helper rather than the primary muscle or the main sort of muscle and you count as half or some other fraction like chin-ups for example counting as like a half set for biceps. and so both of these arguments can't be true.

26:36 Meaning that you know the the triceps, for example, shouldn't count during during bench press, but the chest should count during warm-up sets. They can't both can't be right if the first premise about repetitions in reserve being less than five, and that's the only stuff that really counts is true. I think the resolution of this is we don't think that's true. and there's some some evidence here kind of to inform that. So the paper on this is a meta regression from 2024. the datadriven strength guys and zordos I think are on this paper. this is a type of study that pulls a lot of other studies and asks what kind of relationship is present between the variables not just whether a relationship exists. So this had 140 results from 26 different studies on growth plus a couple hundred more on strength. the best fit for growth. It looks kind of like a straight line, basically continuous from failure all the way out past 20 reps in reserve. So, the benefit of going from like five reps in reserve to failure is about a tenth of a standardized unit, which is a scale that these researchers use when different studies measured muscle in different ways. Comparing FA going all the way to failure versus non-failure head-to-head, it's about a tenth to two/10enths and the range crosses zero, meaning that no difference at all is one of the answers that the data could actually fit. in a more direct study, this is analysis of 67 studies and about 2,000 people. The authors tagged each set as direct or indirect for the muscle being measured for growth. They then they fit the model with three different ways. counting an indirect set as one, an indirect set as half, and an indirect set is zero, and asked which data fit best to the relationship to growth. And they found that half fit the best. it basically suggests that triceps receive some sort of stimulus. It's not like half the stimulus, but it's some nonzero amount of stimulus. my position on this overall, which I think I've stated a few times, any hardline sort of interpretation of effective rep the effective reps model is wrong.

28:40 Meaning like you got to take every set to five repetitions in reserve or or closer, otherwise it doesn't count. That's a hardline version. The way I I see this, it's more of a gradient, particularly for hypertrophy, meaning the closer you get to failure, I think you get a little bit more, but I don't know if it's proportionally more. And I I don't actually don't think so. there's a caveat there I'm going to come back to here in about 120 seconds. For strength, I am actually more confident that the opposite sort of relationship exists to a point provided the weight's heavy enough to drive all of the strength adaptations, neurological based and structural based, which we think is somewhere around in the 60 to 70% of a one rep max range. Provided you're that heavy, I think staying further away from failure is generally better because you get better force production, more higher higher quality force production, less velocity loss.

29:30 and so most of your sets should actually probably be five reps in reserve, four reps in reserve, three reps in reserve outside of like straight up practice. You're doing like a heavier single, which becomes more of a you want to be a little bit more challenging, but still not failure. So Austin, here's the would you rather before we get into some of the some of the nuance here. Would you rather have a client would they take all of their sets to five reps in reserve or all of their sets to zero reps in reserve all the way to failure?

29:55 Which one would you rather have? >> I think that there is a bakedin implication here or I hope that there would be because of the amount of training volume would vary substantially between these two scenarios, right? So, if you said, "I'm going to have my trainee take all of their sets to five reps in reserve," that opens the door for them to do many more sets. Versus if they did quote all their sets to zero reps in reserve, that should, if they're actually taking it that far, substantially limit the amount of volume in terms of sets that they should be able to accomplish, at least if the programming is not really really stupid, and having them do numerous sets all the way to to failure on multiple different exercises. So my big picture overarching bias in this situation independent of any degree of individualization for the person, their preferences, their situation would be for the former would be for taking everything to five reps in reserve and then doing a bit more across a variety of things. as my that's my bias, my preferred strategy. I know that there are certainly those in the highintensity training space that would just say well instead you should just do one set, take it to failure and move on.

30:57 And maybe there are some people for whom that either works well, fits their psychology, maybe that's enough for them to respond to for a period of time. I don't think there's really anybody for whom that is going to be enough for like indefinite or long very long-term improvement. And so there are going to be edge cases, but that's at least my my preference, my bias here. >> Yeah, I think if you saw a bigger difference between like, okay, if you stayed you would all a failure versus staying shy of failure. If you saw a bigger difference in outcomes, you could be more compelled to say, okay, well, we're going to flip this. If you don't have a lot of time, we're going to take it all the way to failure and you're just going to do fewer sets. Now, that may be the practical strategy just because the constraint is time. But if time is not the limiting factor here, suggesting that taking, okay, two or three sets all the way to failure is better than doing six sets to, you know, three reps, four reps, five reps shy of failure. I think that's where the thing gets sticky. And I think that's where we end up kind of favoring the higher volume condition for not just growth, but like just other health benefits because now your total training load has gone up. And I again we go back to this throughput or flux idea sort of sort of thing which we'll talk about at another time. but I think the practical problem with the five RI or going even lighter than that is sort of an anchoring issue wherein it becomes just increasingly harder to predict, well, look, am I actually at five reps in reserve? And so there's some evidence here for sure the closer that people, you know, get go to failure, the more accurate their their prediction tends to be. And I think how this plays out in practice is that if you don't have a recent anchoring to draw from, you just get worse at it the further you're removed from it. So for example, in our programs and a lot of the ways that I program people, the very first week is sort of an on-ramp and they'll do ascending sets. So like squat 4 at 7, 48, 4 at 9 or 4 at 6, 47, 48, whatever you want. And the idea is you sort of triangulate your strength potentially like, okay, here's where I'm at right now. I got three shots at it. I'm orienting myself into a particular ballpark for for strength.

32:58 One way is to just keep, you know, then you sort of change the programming and basically here's your program that we're going to see if it works for you. So, and a person just goes on and does that until it stops working. That's one way to do it. The way I have been sort of migrating towards is like every fifth to seventh week, I'll put a re-anchoring week where they'll again do the ascending sets. Sometimes particularly on machine based exercises, dumbbell based exercises, low stakes exercises overall I'll have people go either closer to failure all the way to failure to sort of reorient themselves like hey did your strength change? Have we had some sort of drift here? Either RP going up when it shouldn't have or RP going down when that really wasn't our target. That's just a strategy and admittedly sort of a hedge to sort of avoid that problem. I don't have like a ton of hard data showing you, look, this is demonstrabably better for muscle growth and strength. That is one way I kind of approach that that issue. But where I overall kind of come at this is that I do think that warm-ups and easy sets do deliver some nonzero amount of training stimulus for both strength and muscular growth. I think for hypertrophy, the closer you get to failure, there's a general there's a gradient sort of like a you where you get more and more growth. It's not linear, right? And so I think there's a sort of tipping point where you get to like RP 8, 7, 8, you know, on on some of these sets and you go above that.

34:22 Yeah, you might get a little more growth, right? But you get a lot more fatigue and so you can't do as much. And so there's some sort of tipping point there, which ultimately has to be balanced against, well, how much training can the person do? Because, you know, on to some extent you can rob Peter to pay Paul and that'll work for a little bit, but then it you know, eventually you're like, well, how do we do more training load? And if you're still constrained, that can be problematic. For strength, on the other hand, I do not have as much sort of squish. I'm more like, look, it's got to be heavy enough to really work well for strength. well is doing a lot of heavy lifting there, pun intended, because I do think lifting almost anything has the potential to make you stronger to some degree. We think the sort of inflection point is somewhere between 60 to 70% of your one rep max.

35:02 And then at after that, it's literally how much how much of that work can you do? And I think staying further away from failure ends up being a little bit better. So if all of that was word salad to you and you're like, "Dude, give me a line." What? What? I'm like, "All right, look, hypertrophy." Somewhere in that sort of 7 to9 range is where I would land, particularly for machines, dumbbells, other things. By that, you mean RP, not rep range. And just to make sure people don't take that the wrong way.

35:26 >> Yep. Correct. Correct. Yeah. Wide v a wide range of viable intensity. So it can be a wide range of reps. But yeah, RP should be somewhere at 7 to N for straight up hypertrophy work particularly that's low stakes machines isolation stuff and then for strength work I'm thinking like RP 4 to6 you know for for the majority of four to seven if you if you like you know whatever but it generally you're staying further away from failure such that you're not losing as much bar speed at the end which tells me that the force production is higher quality and ultimately greater because you can see it move faster.

35:56 Austin, do you have any differences of opinion there? Any steel man of my argument? You want to push back, you want to argue on the internet? >> No. Well, no. And definitely not about this topic. I think your assessment upfront that I don't care that much about this was is accurate. And but I but I don't want to say that in a way that comes off of is dismissive, but instead why I don't tend to care that much about this argument. For example, the idea of it need it should be, you know, three reps in reserve or four or five or six reps in reserve or should I do, you know, three sets or four sets or five sets of four reps or five reps or six reps or things like that. And and the main reason is that I feel that the differences in interindividual response to training >> dwarf the differences in impact of any one or combination of these decisions such that the more practical strategy is just pick something do it consistently for a while see what happens and iterate on that. If you are agonizing over should my sets be to three reps in reserve or four or five that may not be relevant for you or it may be depending on how responsive are you to the training setup in general.

37:09 And if you are somebody because I just did a consult for example yesterday with a guy who he has identified in himself that he does much better in terms of training tolerance in adaptation in in everything to just generally higher higher rep work and doesn't do as well with much higher load lower rep work from like a pain injury you know v various sorts of things and he has struggled repeatedly over time and it's like well why are you kind of beating your head against the wall trying to do this thing that you don't respond that well to when we have you have identified already is something that you do respond well to. And your goals do not require you to do low rep high, you know, load work like for competitive powerlifting. You don't have to do that.

37:48 and and so you're getting frustrated for reasons that are kind of unnecessary here. Whereas somebody else might have completely the opposite sort of phenotype. They might demonstrate or illustrate or experience that, hey, I do way better with doing a couple heavy sets of three and I don't do nearly as well with higher reps. and and if they you know if if there's no reason otherwise why they ought to do something different then then that's totally fine.

38:10 So my take is that individual variation tends to outweigh a lot of these things and that I think partially my gut is that that partially explains why for example in these meta regression studies great big respect for those guys doing that that research you know for for you know slogging through that statistical work and things like that but I also think that the trends that we observe are relatively modest overall it's not like this massive sort of effect difference in in a lot of these situations and I think a Part of that is that it gets kind of washed out by individual variation. I might be wrong.

38:44 Maybe they would have a different take and push back against that. That's totally fine. but that that's kind of the way I approach it in practice is not being so concrete with these very specific targets, but rather saying like here are here's what the general like literature and our experience illustrates as like reasonable trends on which to base our initial intervention. And then we just kind of like tinker with it based on your response. And then the last thing I would say is let's say you're agonizing over should I do something to like three reps in reserve or four reps in reserve or five reps in reserve yet over the course of a year you miss a total of 10 training sessions for whatever reason. I think you missing 10 training sessions probably outweighs >> you agonizing over you know over those types of things or you skip you know a total of like 30 sets across the whole training year. I suspect that that also outweighs, you know, the difference of whether I did one extra rep on these sets and took it an extra rep close to failure or not. and so I think again that's where I'm like putting my emphasis on the variables that matter much more. the even if it is maybe not optimal from like a strength stimulus on a per set basis, if you just like do all the sets over the course of the year, you're probably going to end up ahead versus doing the perfect proximity to failure, but then just like skipping some sessions, going on vacation, taking time off, which I'm not saying is a bad thing. That's just like life. People are going to do that. But then it's like, why are you agonizing over these tiny details? Which now, like that's my case for why I don't care.

40:06 >> I think the agonizing is maybe the more important. >> Exactly. >> I I think, you know, I've been wrecking my brain for over a decade trying to find a way that I feel like adequately measures training load, which is not just the amount of training that you're doing, but the nature of it, right? So all of the other variables kind of combined together. It can't be tonnage, just weight times, reps. It can't be the number of hard sets, the number of fractional sets. Not to say that's bad.

40:34 It's very pract. What I'm getting at is the number doesn't tell you what you want. What you're trying to figure out is a sort of dose response relationship kind of or like a mathematical formula you can use to like lay out and then project your training, right? And so, you know, a training stress score where you would take the you'd have a modifier for the exercise. Is it compound? Is it isolation? Is it free weight? Is it machine? and then the average intensity and then the RP and then how many how much volume you did and you would you know it's not just a you'd have to come up with some sort of algorith or or equation that plugs all these variables in and gets you a number and even then you take that number and you have to apply it to a large population and come out with outcomes that are tracked together and then it gets so noisy and I just >> I think the main challenge that you're you know talking around but but not explicitly articulating is that in the context of this our world strength training resistance training, we do not have a perfect measure of internal load.

41:30 >> and you know, if you contrast it with the endurance training world where, for example, they can base a lot of things on, you know, having good heart rate data and then maybe accounting for, you know, duration and peak heart rate and average heart rate and heart rate reserve and and predicted heart rates and then ambient conditions, heat and humidity and how that might impact things and all sorts of things. You can get a lot more granular and get a better sense of just like looking at the data and being like, "Oh, damn, that looked like a very, very difficult session."

41:54 You know, in in strength training, our best met, you know, quote unquote metric, if you want to even call it that, of internal load is like, yeah, the person's kind of subjective rating of it, which is fine, for our purposes, as it has been for a very long time, but it is not nearly as like granular and lets you make a lot of prospective decisions, in an anticipatory manner and things like that. >> I just want numbers.

42:15 I won't get them. >> Okay, that's it for this free preview of our direct line from August 2026. The rest of it is on barbell medicine plus and there are 10 more questions there as well including do you need a $5,000 machine to fix your back and how to find a physical therapist who won't just put a hot pack on you and call it a day and what the internet has done to dopamine. Barl Medicine Plus subscribers also get the articles that I've been writing in our community section. None of these have been published yet. First one is commentary on the military's new testosterone clinical practice guideline. a longer or deeper look at how many calories it actually takes to build muscle. Some practical recommendations and whether different diets produced different health outcomes when the weight loss was equated. This study was keto verse the world and some of the keto influencers are misquing it. Go figure. And then finally, another article on statins in older adults finally, which is the discussion of the star trial. All that and more if you subscribe to Barb Medicine Plus. It's $9.95 a month. You get the direct line in full every month.

43:18 You get to ask your own questions. You also get ad free listening to all of our episodes, early access to all of our episodes, bonus podcasts, bonus videos, bonus articles. Plus, you get 10% off all of our programs and our programming library prescription, plus discounts on consultations, seminars, learning, and everything else. You can try it for just a dollar a month. The link is in the description below. Hope to see you there. For everyone here at Barpell Medicine, I'm Dr. Jordan Fagenbomb. That's Dr. Austin Barack.

43:43 We'll see you next week and every week right here on the Barpell Medicine podcast. Oh yeah. Oh yeah.